Applying a systems perspective to understand the health effects of holistic housing renovation in a deprived neighbourhood in the Netherlands: Development of a causal loop diagram

Whereas ‘systems thinking’ rapidly becomes popular in public health, and whereas many housing interventions have been evaluated in ‘traditional ways’, we aim at moving the field further by describing the application of a Causal Loop Diagram for the purpose of the evaluation of a complex public health intervention: holistic housing renovation. Holistic housing renovations have the potential to reduce health inequalities by addressing physical housing issues and socioeconomic problems of residents in social housing in deprived neighbourhoods. We developed a Causal Loop Diagram, combining perspectives from stakeholders and scientific literature, visualizing the complex dynamics via which holistic housing renovations can impact health of residents in social housing. We identified six interconnected mechanisms which potentially generate health effects in different time frames, with negative effects primarily occurring in the short term, while positive health effects may take longer to manifest. Our paper shows how constructing a CLD can help to assess effectiveness of housing interventions by formulating hypotheses about their impact. • Evaluating holistic housing renovation requires a systems perspective. • Stakeholder-derived information is crucial to evaluate complex interventions. • A Causal Loop Diagram shows dynamics between holistic housing renovation and health. • Core dynamics start off before, during and after renovation. • Social interventions may mitigate renovation stress.